Almost 25% of preschool age children are overweight or obese. The early childhood home environment created by parents is crucial in establishing the behaviors and practices consistent with energy balance and healthy weight. Unfortunately, less than optimal eating and physical activity patterns are becoming more common in younger children. Addressing these eating and activity patterns during early childhood is vital to reducing risk factors for disease over the life span. Behavioral family-based interventions (BFI) have demonstrated success in facilitating improved weight status in obese elementary school children. These interventions empower parents to be agents of change and teach parenting skills such as differential attention, contingency management, modeling and stimulus control to modify the family environment and help motivate and support their children to adopt healthier eating and physical activity habits. However, little published research has examined the impact of these interventions for overweight and obese preschoolers. Moreover, most weight management trials have consisted of efficacy studies conducted in university medical centers by highly-trained clinical researchers and multidisciplinary teams. Little research has examined the effectiveness of BFI to address childhood obesity in real-world community settings, let alone underserved populations. The problem of childhood obesity is notably pronounced in rural areas, where the prevalence of pediatric obesity is 25% higher relative to non-rural areas. Unfortunately, children and adults of rural areas represent one of the largest medically underserved populations in the country. A next logical step in this line of research is to evaluate the impact on child weight status of a community-based behavioral family intervention tailored for preschool age children and their parents in medically underserved rural settings. We propose to conduct a Community-based Healthy-lifestyle Intervention for Rural Preschoolers (The CHIRP Study), a two-year multi- site randomized controlled trial that evaluates the effectiveness of a BFI designed to promote healthy lifestyle habits and weight management in an important and underserved population, preschool age children and their parents in rural settings. The current study will provide pilot data to develop and support a larger, full-scale tril. Ninety-six child and parent dyads will be randomly assigned to either a 4-month long BFI or a Wait List Control (WLC). Children (ages 3 to 6 years) and their parents assigned to the BFI will participate in 12 in-person group treatment sessions across four months. The BFI will be delivered in rural communities at Cooperative Extension Service offices and will involve simultaneous, but separate treatment groups for both the child and their parent(s). Child BMI z-score, physical activity, nutritional intake, parent BMI, and home environment variables will be assessed at baseline, post-treatment (month 4), and follow-up (month 10). Dyads assigned to the WLC will receive the BFI after the Month 10 assessment. If successful this intervention offers excellent potential for wide spread dissemination to address a pressing health disparity and public health problem. PUBLIC HEALTH RELEVANCE: The proposed study will fill a critical gap in the literature regarding Behavioral Family Interventions and the treatment of obesity for very young children and their families. The study will have important public health implications for the treatment of pediatric obesity in underserved rural settings.